Direct access is certainly an ongoing issue. I would suggest looking to other countries where direct access is already in place…Canada, New Zealand, etc…places where it’s been in place yet no therapist has ever been reprimanded/charged with harming a patient due to direct access issues. Consider cost containment issues as well. In the US, we are moving towards a paradigm shift where allied professionals are able to serve in limited front line care…example: nurse practictioners practicing as front line providers for basic medical care…why not PTs for musculoskeletal care. Consider research studies such as the one by Freedman that found that 85% of all medical school graduates failed to demonstrate competence in a basic musculoskeletal exam or that only 1/3 third of medical schools require physicians to take courses in musculoskeletal medicine. Finally, there was a study in Spine this summer that found that only 1/2 of physicians adhered to standard care guidelines for acute low back pain and that the number was only 1/3 for orthopedic surgeons (the very people who are supposed to be "the most competent" in delivering musculoskeletal care).

In otherwords, are physicians really the best choice for directing musculoskeletal care? Perhaps is the PT who should be assuming this (aside from major injuries or other medical issues).

Another significant issue is that of physician owned physical therapy clinics (called POPTS). The arguement is that it is a financial conflict of interest and raised unfair competition with PT owned clinics. POPTS have a reputation for overutilization of services.